DefinitionThis section has been translated automatically.
Polyätiologic, acute, single or irregular recurrent, 1-3 day persistent, hereditary or acquired, painful or burning, swelling (edema) of the cutis/subcutis and/or the mucosa/submucosa. Life threatening can be swellings of the upper respiratory tract (pharynx and/or larynx).
ClassificationThis section has been translated automatically.
- Classification of angioedema of the head and neck region (varies according to Bas et al. 2013)
- Histamine-mediated angioedema (1%!)
- non-histamine-mediated angioedema
- Acute phase mediated angioedema
- inflammation-induced angioedema - e.g. due to peritonsillar abscess or acute tonsillitis with accompanying inflammatory reactions (about 79%)
- tumour-induced angioedema (7%)
- Bradykinin-induced angioedema (8%)
- idiopathic angioedema (5%)
- Acute phase mediated angioedema
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Clinical featuresThis section has been translated automatically.
Acute phase edema: Inflammatory edema of the head and neck region is the most frequent event in a general consultation, accounting for about 80% of all acute edema in this region. The causes are infectious-inflammatory diseases such as peritonsillar abscesses or acute tonsillitis with concomitant inflammatory oedema. These are painful, mostly unilateral protrusions of the soft palate with an oedema of the uvula.
Bradykinin-induced angioedema: This is the second most frequent group of acute oedema of the head and neck region with 8%. They affect about 30,000 people/year in Germany. Bradykinin-induced angioedema is most often caused by the use of ACE inhibitors. More rarely, angiotensin type I receptor blockers (Sartane) are the cause. Bradykinin-induced angioedema occurs mainly in the first 3 years of intake. However, there are also cases where much longer latency periods (up to 11 years) have been observed.
Histamine-mediated angioedema: mainly in patients with acute or chronic urticaria. Here the clinical appearance leads quickly to the diagnosis. In classic type I reactions, the relationship between exposure and clinical response is usually evident and also memorable to the patient.
Hereditary angioedema (see Angioedema hereditary)
TherapyThis section has been translated automatically.
Diagnostic path in acute angioedema of the head and neck region
- Alerting an Airway team (anaesthetist, emergency doctor)
- Securing the respiratory tract (oral examination)
- Where is the angioedema? (tongue, soft palate, hypopharynx/larynx, facial lip)
Therapy of histamine-induced anigoedema
- Clemastine 2 mg IV.
- Prednisolone 500 mg IV
- Adrenaline if necessary with circulatory involvement (0.3-0.5mg adrenaline i.m.)
Therapy of bradykinin-induced angioedema
- Icatibant 30 mg s.c. (effect after 30 to 45 minutes)
- alternatively, and still experimentally, C1 inhibitor concentrate (Berinert P, Cinryze, Ruconest) or administration of a kallikrein inhibitor (Kalbitor)
- if necessary, adrenaline with circulatory involvement (0.3-0.5mg adrenaline i.m.)
LiteratureThis section has been translated automatically.
- Bas M et al (2013) Angioedema of the head and neck region. Allergo J 22:118-123
- Firazyr. [http://ec.europa.eu/health/documents/community-register/2018/20180426140571/anx_140571_en.pdf EMA SUMMARY OF THE CHARACTERISTICS OF THE MEDICINE]
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